INITIAL GLUCOCORTICOID BRIDGING IN RHEUMATOID ARTHRITIS: DOES IT AFFECT GLUCOCORTICOID USE OVER TIME?
Authors: L. Van Ouwerkerk et al.
Glucocorticoids (GC) are very effective in controlling inflammation in the short-term, but carry a risk of habituation and difficulties to discontinuing them. This study combined three randomized trials to analyse long-term GC use between RA patients randomized to treatment with or without initial GC bridging therapy. After a mean of 35 weeks of initial GC use (“bridgers”), significantly more patients still used GC at 1 year (OR 3.27 (95% CI 1.06; 10.08)). Moreover, the cumulative GC dose was significantly higher for the bridgers (2889 mg), which can be translated to a difference of 4mg a day for 2 years. The incidence rate ratio (IRR) for RA flares was similar between the groups (IRR 1.14 (95%CI 0.86; 1.50), but the IRR for DMARD changes was significantly lower in the bridgers (IRR 0.59 (95%CI 0.38; 0.94)).
GC are still commonly used in Europe, even though the problems (osteoporosis, infections, cardiovascular events …) are well established. While rheumatologists often initiate GCs only as a short-term bridging therapy, they should be aware that the likelihood that patients keep this therapy for over a year is 3 times higher than if they did not use GC bridging. Perhaps, rheumatologists need to explore ways of administering GCs less likely to induce habituation than low dose oral therapy, such as parenteral administrations. On the positive side, GC use was associated with a better DMARD drug maintenance.